腹腔镜联合胆道镜胆总管探查取石术的应用探讨

目的 探讨腹腔镜联合胆道镜在胆总管探查取石术中的临床应用价值.方法 回顾分析48例胆囊结石合并胆总管结石患者,应用腹腔镜联合胆道镜治疗的临床资料.结果 48例患者均手术成功,无中转开腹,手术时间(2.1±0.4)h,住院时间(14.6±3.1)d;放置T管者术后2周经T管造影,无残石且末端通畅的,术后3周拔管;3例有残石,2例于术后6周经T管窦道用胆道镜取石,1例用甲硝唑及生理盐水冲洗后排出,全组患者无严重并发症发生.结论 腹腔镜联合胆道镜胆总管探查取石术安全可靠、创伤小、并发症少,是治疗胆总管结石较好大的微创术式,值得临床推广应用.

The Laparoscopy Combined with Choledochoscopy for Common bile Duct Exploration Application

Objective: To investigate the clinical application of laparoscope combined with choledochoscope in common bile duct.Method: Retrospective analysis of 48 cases of cholecystolithiasis and choledocholithiasis patients,application of laparoscopy combined with choledochoscopy in treatment of clinical data.Result: All 48 patients were successfully,without conversion to open operation,operation time,(2.1 + 0.4) h,hospitalization time(14.6 + 3.1) d;T tube placement in patients after 2 weeks after T tube radiography,no residual stone and the end of unobstructed,3 weeks after extubation;3 patients had residual stone in 2 cases,postoperative 6 weeks after T tube sinus with endoscope of biliary tract stone,1 case with metronidazole and saline flush after discharge,all patients had no serious complications occurred.Conclusion:Laparoscopic common bile duct exploration combined with stone removal is safe and reliable,less trauma,fewer complications,is the treatment of common bile duct stones used in minimally invasive surgery,it is worthy of clinical application.